NCG020351_DMR_20220713

6llOi1AM>>N TER DISCHARGE P1�J.�,0AVITOJ1'a, NG RCL!POKY(MR)
please Nail Original And One Copy To Mailing Address Below _—
Part A:F'ocility Information
Samples Collected In Calendar Year-. /Sf 202,X _ (ali sainples shaail be reported within 30 days i'o@lowirag monitoring period)
Certificate Of Coverage No. NCG92 6 3 71 e County OF Facility _ ' 1 �—
Faa iiity i°3arrgte _Cr�►►st °^ NaanBne-of-Lairora -y
if acility Contact �_� Lab Certification 4
Facility Contact Phone No. Y) 3zo 6 Y 3`7
Part B:Land Disturbance and.Process Area 1ylonitorin Re uirernents Part C: vehicle Maintenance Moraitor•in Re tdrements
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Part D:Storm Event Characteristics p
1Totai Event Precipitartiola(inches)*_ C�..®� TotaaR Event Precipitation(inches), R CEI li
Event Duration(hours)._�_ Event>IDrrr•a atom(hours): UL 2 Q 2022
(if a separate storm event is sampled) CE'*' r
RAL Part E.- Certification DWR. A
"I certify,under penalty of!1°tvv,that this dldBceflrrr RA and all att2 chinAents were prepared under eery direction or supervision in accordance With a
system designed to assure that quaifledl per°5drrrnRe) pr'oper°iy gather and evaluate the information srrtbn-fl ted. Based an my Nquir•y of the person
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o any knowledge and lbe iet',true,accurate,and complete. I am aware that-t re are significant penalties for srabn9tting ffa95e infor'Mtioan,
incCiudtng the possibility of fines and Arrri3r"ison meat for iSnewAng vjolations." °
(gig tur-e of Per rrritttee) a )
Part F:Mailing,41ddress
Aare- Central Files,DENR,RT.C.Divlsiorn of Water Qrraaiity, 1617 MAl Sanr Acce Center,RaHeigh,IBC 2769 -1617